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Shift of COVID-19 limits to local control creates side effects

When the Kansas Legislature gave local governments the power to opt out of the governor’s emergency orders this year, the move came with some side effects. Dealing with the coronavirus pandemic at the local level has created tension and confusion, especially in rural  areas where officials face choices they couldn’t have imagined just months ago.

 

Jim Minnix is used to worrying about infectious diseases and community spread in the bovine population. He’s a cattle producer. In 2020, those concerns have shifted to humans, specifically the nearly 5,000 residents of Scott County in western Kansas where Minnix is presiding commissioner.

As with other counties in Kansas, the County Commission doubles as the board of health. That local role, reinforced by action this year by the Legislature, has placed decisions related to COVID-19 spread squarely in the laps of Minnix and his two fellow commissioners.

“It’s sure taking a few more meetings,” Minnix says.

Despite being a neighbor to Finney County, where cases spiked early because of infections in a meat processing plant west of Garden City, Scott County’s number remained low through the early months of the pandemic. On July 2, the county Health Department reported 16 cases, and all of the patients who tested positive had completed quarantines and were considered recovered.

Commissioners felt confident that evening when they voted to opt out of Gov. Laura Kelly’s executive order requiring Kansans to wear face coverings in public spaces. A bill that Kelly signed in June, as a compromise with legislators who wanted to curb her authority related to pandemic measures, gave county commissions the final say on masks and other public health mandates.

But a month later, conditions worsened. On July 24, the health department had determined that cases were spreading within the Scott County community. Before that, people who tested positive had contracted the virus outside of the county. The health department reported 38 cases on Aug. 6, 10 of which were still considered active.

On that evening, the commission met for a special meeting, called by Minnix.

Members listened to the county’s health director, emergency management manager and a doctor who consults with the health department.

“They are the professionals,” Commissioner Gary Skibbe says. “We’re elected officials, and we’re not fluent in medical terms and decisions. We have to rely on the guidance of the health people.”

By the end of the meeting, the commissioners voted unanimously to require masks to be worn in public places.

“We wanted to keep our county healthy economics-wise and medical-wise,” Minnix says. “We wanted the schools to reopen. Online learning was not an ideal situation for us. Another of our goals was not overwhelming the medical resources that we have here.”

Minnix and Skibbe say they haven’t encountered much animosity over the mandate, and that compliance seemed to be mixed.

“I have not had anyone contact me, pro or con,” Skibbe says. “We’re a small community, and I would say we govern with a lot of trust.”

Even so, said Minnix, who, after 26 years on the commission, is running unopposed in November for a vacant seat in the Legislature, the work of local government this year has been stressful.

“I have a lot more gray hairs since the coronavirus,” he says. “I’d far rather deal with water and landfills and budgets.”

 

  • Members of the Sedgwick County Commission and the Wichita City Council felt more than the usual summer heat when the question of mask requirements came before both bodies.

‘A POLITICAL DISEASE’

Throughout Kansas, local leaders are finding themselves in roles they couldn’t have foreseen a year ago. Although county commissions have acted as boards of health since 1885, many commissioners have not had to pay much attention to that responsibility before this year.

Now they are being called upon to make crucial public health decisions in a politically charged environment. Elected city officials have had to get involved in COVID-19 decisions also – sometimes enacting restrictions contrary to those made by elected county officials.

“We’re fighting this fire, and I feel like we’re all alone,” says Jeff Perez, mayor of Parsons in Labette County.

A survey by the Kansas Health Institute reported that, as of Aug. 11, 33 of Kansas’ 105 counties had enacted some level of public health restriction, such as requiring masks, limiting crowd sizes or setting shorter hours for restaurants or bars. Although that number seems small, the state’s most densely populated counties have taken the most stringent precautions. More than 70% of Kansans lived in counties with mask mandates at the time of the survey. (A subsequent report this week showed little in the way of change.)

While many people applaud the Legislature’s move to give local governments and school boards the power to opt out of the governor’s emergency orders, the coronavirus pandemic has created tension and confusion, especially in rural areas.

“It’s such a political disease,” says Dennis Kriesel, executive director of the Kansas Association of Local Health Departments. “Because of that there’s a lot of second-guessing that’s going on with the county commissions and health officers.”

Kansas statute 65-201, passed in 1885 and modified a few times since, designates county commissions as boards of health, and directs them to appoint a medical professional to advise them as the county health officer. Some commissions choose to hire both a health officer – who can be a nurse, public health expert or health department administrator – and a physician as medical consultants.

“Kansas is a strong local control state. That’s true for public health as well,” says Charles Hunt, a former state epidemiologist and a senior analyst for the Kansas Health Institute.

Before COVID-19 arrived in Kansas, county commissions were usually content to let their health officers and health departments make decisions about immunizations, mental health services and related topics.

“Most people who seek local elected office at the county level are motivated by certain issues, but health isn’t usually one of them,” says Kriesel, who worked at the Kansas Association of Counties before moving to his present job.

The pandemic forced commissioners to weigh the advice of their experts against public sentiment and the interests of businesses that sustain their communities.

“The reality is the local health officers have always served at the pleasure of the board,” Hunt says. “The board of commissioners has always been in charge. The dynamics have shifted a little bit.”

 

In late July, the executive board of the Kansas State High School Activities Association gave the go-ahead for extracurricular activities this fall, including football. A few days later, Lee Norman, secretary of the Kansas Department of Health and Environment, expressed his reservations, saying “I don’t have a crystal ball, but I think it’s going to be a problem.” The final call was up to local schools. Most districts, like Holcomb and Scott City, here tangling in junior varsity football as Holcomb fans look on in mid-September, voted to start athletic seasons.

 

CITIES TAKE ACTION

Lonie Addis is the senior county commissioner in Kansas. He’s served in Labette County for 38 years. Usually the commission carves out a few hours at the beginning of the year to talk with health experts. “One of the things we always spend some time talking about is a pandemic,” he says.

But those informational sessions didn’t really prepare commissioners for the decisions they’ve had to make this year, or the intensity surrounding their actions.

“It’s kind of overwhelming,” Addis says.

On July 6, Addis and a fellow commissioner met to consider the governor’s mask order. A third commissioner participated by telephone. They convened in a small room in the courthouse in Oswego, where a number of health leaders urged the commission to require the county’s nearly 20,000 residents to wear face coverings in public. Speakers included Brian Williams, the CEO of Labette Health, which operates a 99-bed hospital, among other facilities, and serves a six-county area in southeast Kansas, and county health department administrator Lisa Stivers. The health professionals wore masks. The commissioners didn’t.

The health professionals wore masks. The commissioners didn’t.

“We weren’t even close to social distancing,” Addis acknowledges. “And then when people tried to speak through the masks you couldn’t hear them. So they had to take off their masks to talk.”

The commission voted 2-1 to opt out of the governor’s mask order. Addis, who voted in the majority, says the county counselor, county attorney and sheriff had all advised that such an order would be unenforceable.

“Honest to God, if I thought masks would keep the whole county safe, I’d ask everyone to wear one,” he says. “We couldn’t enforce it. Our hands were tied.”

Addis says it pained him to reject the advice of the health professionals. “I have the greatest respect for Brian Williams. He’s been a godsend for us. I think we have the best county hospital in the state of Kansas, if not the Midwest.”

Williams was surprised when commissioners opted out of the mask mandate.

“I know they’re committed to health. I know they’re committed to the hospital,” he says.

“It’s very clear that wearing a mask prevents the transferal of a communicable disease like coronavirus. I think a clinical and scientific fact became politicized into an individual rights issue. I was surprised; I accepted it; we moved on.”

But while Labette County said no to requiring masks in public, leaders of its most populous city came to a different conclusion.

Perez, the mayor of Parsons, spent a lot of time around the July 4 holiday looking at COVID-19 numbers in Labette County and surrounding areas, including nearby cities in Missouri, Arkansas and Oklahoma.

“I started getting data from local doctors,” he says. “Joplin (Missouri) was spiking at that time. Arkansas was spiking. Fayetteville (Arkansas) had just implemented a mask ordinance.”

Perez, who owns a golf course in Parsons, says he was concerned about health rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute that place Labette County among the lowest in Kansas.

“It takes a lot of work to keep our noses above water,” he says. “We do everything we can to instill public safety.”

He recommended to the four city commissioners that Parsons enact a municipal mask policy. He proposed an ordinance modeled on Fayetteville’s, which Perez says relies more on voluntary compliance than enforcement.

Perez was not the only Kansas mayor to ask a city to depart from its county’s COVID-19 policies. Others are Emporia, Hays, Manhattan, Marion and Winfield. Although Sedgwick

County now has a mask order, Wichita enacted its municipal order first.

In Parsons, the commission met for four hours on July 6. A number of residents attended, with some of them watching on monitors in the lobby.

“Every time an anti-mask person would come up to speak, you could hear all the whoops and hollers going on out there,” Perez says.

Undeterred, the commission unanimously passed the mayor’s proposal. Perez said he’s received plenty of comments since the vote, via the phone, email and in person. “Some support it,” he says. “Some are not so kind. Some are pissed off.”

He takes the flack in stride. “Remember, I own a golf course, so I get along with everybody,” he says. “I do believe we kept a brush fire from occurring here in Parsons. We’ve got something special in this area, and I just want to make this comfortable way of life in rural Kansas as safe as I possibly can.”

 

A look at local control of COVID-19 response

The Kansas Health Institute collected this information through a survey in collaboration with the Kansas Association of Counties and supplemented it with online searches for published orders, announcements on social media and local news sites. Counties that have adopted restrictions are shown in this map, and official actions that use only the language of guidance (e.g., “should” or “recommend”) are not considered restrictions. For mask orders, counties
that either adopted an order by official action or did not take official action to opt out of the state mask order are considered to have a restriction in place. For the statewide school mitigation order, county commissions that have taken official acts to opt out of some or all of the order are included. Any actions taken by a local school board or school district are not provided in this table. Counties may have policies in place that were not identified by this approach and therefore are not included.

 

THE IMPORTANCE OF RELATIONSHIPS

While COVID-19 has required stamina and thick skins from elected officials, its battles have left bruises on some of the health professionals who are also in the trenches.

“My spirit is maybe a little more broken than back in March,” says Jennifer Bacani McKenney, a family physician and the health officer for Wilson County, northwest of Parsons.

Her County Commission overruled her advice and opted out of a mask mandate, barely allowing her time to present her case for why face coverings were needed, McKenney says.

Her stance in favor of restrictions has damaged lifelong relationships. One evening this summer, McKenney invited her hard working clinic staff to her home for an outdoor, socially distanced gathering. They hadn’t been there long before a man drove by, filming what was going on.

Within minutes another resident had a video up on Facebook, accusing McKenney of not following the advice she recommended for others.

“There are people I’ve known my entire life,” McKenney says. “I’ve golfed with that guy.”

McKenney explains that she receives plenty of encouragement. “I know in my heart that there are many more people supportive of what I’m doing and the health department is doing,” she says.

But Kriesel says that, as of late August, four county health officials had resigned since the start of the pandemic, four others had retired and two had been fired. Six of those 10 served as health officers to their county commissions.

“Some have received threats,” Kriesel says. “Some of them feel like they’re a punching bag for their commissioners. Some are frustrated by orders from the state. There’s a lot of fatigue.

There’s so much testing, so much contact tracing. There’s so many cases. It’s the grueling nature of COVID.”

Gianfranco Pezzino, a former state epidemiologist, serves as the health officer for Shawnee County, which includes Topeka. His County Commission worked with him to come up with a compromise ordinance that requires face coverings in public places where social distancing can’t be achieved. 

But Pezzino has been monitoring actions elsewhere in Kansas as part of his job as a senior fellow for the Kansas Health Institute, and knows that not everything is going smoothly. (Editor’s note: Pezzino announced on Oct. 29 that he’d be leaving the health officer’s position.)

“People like me have always thought that if we present the right data in the right way we’ll get good policy,” he says. “That’s no longer the case.”

Local responses to the pandemic too often have been based on unsubstantiated perceptions or rumors, Pezzino says.

“The amount of misinformation that’s circulating is huge,” he says. “There was a time when having local knowledge was sufficient to gain credibility in a community. We don’t live in those times anymore. The challenge is: How do we work in this new environment?”

Part of the answer, he thinks, is better relationships. Before the pandemic, Pezzino had little interaction with his commissioners. “I always make a point of meeting them after they’re elected,” he says. “After that – very close to nothing.”

In the future, elected county officials and health officers will have to be more deliberate about forming relationships and exchanging information, Pezzino says.

“Something that would help even more, in my mind, is to broaden the base of the decision-making process,” he adds.

In many Kansas counties, coronavirus decisions are being made by only four or five people — three county commissioners, a health officer and perhaps a health department administrator, Pezzino says.

“Things can become personal quickly,” he says.

“Any one person with strong opinions can affect the decision-making process very heavily.”

An advisory panel with credible people from different backgrounds and occupations could help officials make informed decisions, Pezzino says. “I for one would love to have that kind of sounding board.”

A better communications strategy would also help, Pezzino says. “We’re always playing catch-up. We’re always lagging behind with our message.”

Communication strategies, engaging unusual voices and even productive relationships are difficult to establish in the midst of a crisis. Those tasks will be left to the people who seek elected office and jobs in county health departments after the crisis.

Addis, the state’s longest-serving commissioner, says he decided even before the pandemic swept into Kansas that this term, which runs through 2022, would be his last. “I always thought the county needed me,” he says. “Now I think the county needs someone else.”

But while he’s in office, Addis is doing his best to work across factions with health professionals.

“There’s a lot of cooperation between us and the medical community, if you take masks out of the equation,” he says. “We still have respect for each other, and that’s not going to change.”

 

A version of this article appears in the Fall 2020 issue of The Journal, a publication of the Kansas Leadership Center. To learn more about KLC, visit http://kansasleadershipcenter.org. Order your copy of the magazine at the KLC Store or subscribe to the print edition.

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